The focus of this study is on vascular access for hemodialysis. This is a randomized clinical trial testing 3 educational approaches to help patients with advanced chronic kidney disease prepare for placement of hemodialysis vascular access. Study participants will each be assigned to one of the 3 approaches: 1) "Education", in which participants will be given a video and brochure that provide information about the types of vascular access and what can be expected before and after the vascular access is placed, 2) "Education-Plus", in which participants will be given the video and brochure and will also have sessions by telehealth with a motivational interviewing coach to provide additional support around vascular access placement, and 3) "Usual Care", in which participants will have the usual education provided by their kidney doctor and clinic staff just as if they were not in the study. Participants in all 3 groups will be asked to complete questionnaires by telephone and may be invited to be interviewed about their experience with the study intervention at the end of the study. Study participation will last for about 12 months, with most of the study activities taking place during the first 3 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
360
Participants are provided with the "Getting Ready: Your Vascular Access Journey" video and brochure about hemodialysis vascular access. The video is available for viewing via smartphone or computer. Both the brochure and video were created with input from patients with chronic kidney disease.
Participants receive coaching with telehealth-based motivational interviewing designed to prepare participants to move forward with vascular access creation. Motivational interviewing will consist of a minimum of 3 and maximum of 8 telehealth sessions with a coach. The coach will use patient-centered communication skills to work though the stages of pre-contemplative, contemplative, preparation, action, and maintenance of an arteriovenous vascular access.
Participants receive the non-standardized vascular access counseling and referral to the chronic kidney disease education class that comprises the standard care provided by their nephrology clinic.
Nephrologists and clinic staff receive monthly, provider-specific, lists of patients potentially appropriate for AV access planning based on eGFR thresholds and kidney failure risk. These criteria identify patients at risk for progression to dialysis and are congruent with evidence-based guidelines for optimal timing of AV access evaluation referral.
Johns Hopkins University
Baltimore, Maryland, United States
RECRUITINGUniversity of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
RECRUITINGUniversity of Pennsylvania
Philadelphia, Pennsylvania, United States
RECRUITINGSurgery for Creation of Hemodialysis Arteriovenous Access (Effectiveness outcome)
The proportion of participants who have arteriovenous access creation surgery.
Time frame: Within 12 months after randomization or before hemodialysis initiation, whichever comes first
Scheduled Appointment with Surgeon for Vascular Access Evaluation (Effectiveness outcome)
The proportion of participants with a scheduled appointment with a surgeon for evaluation for vascular access creation.
Time frame: Within 12 months after randomization or before hemodialysis initiation, whichever comes first
Completed Appointment with Surgeon for Vascular Access Evaluation (Effectiveness outcome)
The proportion of participants with a completed appointment with a surgeon for evaluation for vascular access creation.
Time frame: Within 12 months after randomization or before hemodialysis initiation, whichever comes first
Imaging for Planning Arteriovenous Vascular Access Creation (Effectiveness outcome)
The proportion of participants with completed vascular imaging via ultrasound or angiography for planning arteriovenous vascular access creation surgery.
Time frame: Within 12 months after randomization or before hemodialysis initiation, whichever comes first
Usable Arteriovenous Vascular Access (Effectiveness outcome)
For participants who start hemodialysis, the proportion with a usable arteriovenous access at dialysis initiation.
Time frame: Up to 4 years after randomization (full duration of the trial)
Vascular Access Knowledge (Effectiveness outcome)
The change from baseline in vascular access knowledge as measured by the Patient Perceived Vascular Access Knowledge scale. The total score ranges from 0 to 10, with higher scores indicating a higher level of vascular access knowledge.
Time frame: 12 weeks after randomization
Decision Self-Efficacy (Effectiveness outcome)
The change from baseline in decision self-efficacy as measured by the Decision Self-Efficacy Scale. The total score ranges from 0 to 11, with higher scores indicating a higher level of self-efficacy when making decisions about hemodialysis vascular access.
Time frame: 12 weeks after randomization
Preparedness for Decision-Making (Effectiveness outcome)
A participant's level of preparedness for decision-making as measured by the Preparation for Decision-Making Scale. The total score ranges from 0-100, with higher scores indicating a higher perceived level of preparation for decision-making.
Time frame: 12 weeks after randomization
Characteristics of Eligible Patients - quantitative reach assessment (Implementation outcome)
An assessment of the demographic and socioeconomic characteristics of patients who are eligible for the trial.
Time frame: Pre-Enrollment
Characteristics of Enrolled Participants - quantitative reach assessment (Implementation outcome)
An assessment of the demographic and socioeconomic characteristics of patients who enroll in the trial.
Time frame: Baseline
Characteristics of Participants who Complete the Trial - quantitative reach assessment (Implementation outcome)
An assessment of the demographic and socioeconomic characteristics of participants who complete the trial.
Time frame: 12 months
Characteristics of Participants who Withdraw from the Trial - quantitative reach assessment (Implementation outcome)
An assessment of the demographic and socioeconomic characteristics of participants who withdraw from the trial.
Time frame: From eligibility until 12 months
Declined Enrollment - quantitative reach assessment (Implementation outcome)
The reasons for declining enrollment as documented in screening logs and provided in aggregate for an enrolling center.
Time frame: Pre-enrollment
Reasons for Participation - qualitative reach assessment (Implementation outcome)
The reasons for participation and non-participation as identified through qualitative interviews
Time frame: 12-16 weeks after randomization
Reasons Nephrologists Opt-Out on Behalf of Patients - qualitative reach assessment (Implementation outcome)
The reasons that nephrologists opt out of having an eligible patient approached by the research team for possible enrollment as identified through qualitative interviews.
Time frame: Up to 4 years after trial initiation (full duration of the trial)
Acceptability Intervention Measure - quantitative acceptability assessment (Implementation outcome)
The acceptability of the intervention as measured by the Acceptability of Intervention Measure (AIM). The total score ranges from 1-5, with higher scores indicating a higher level of acceptability of the intervention.
Time frame: 12 -16 weeks after randomization
Acceptability of Intervention Content, Delivery, and Accessibility - qualitative acceptability assessment (Implementation outcome)
The acceptability of the content, delivery, and accessibility of educational materials and motivational interviewing coaching as identified through qualitative interviews.
Time frame: 12 to 16 weeks after randomization
Chronic Kidney Disease Class Attendance - quantitative fidelity assessment (Implementation outcome)
The proportion of participants who attend a Chronic Kidney Disease education class provided by their nephrology clinic
Time frame: Within 12 months
Receipt of Educational Materials - quantitative fidelity assessment (Implementation outcome)
The proportion of participants with confirmed receipt of the "Getting Ready" brochure (only be assessed for the Education and Education-Plus groups)
Time frame: Within 12 weeks after randomization
Viewing of Video - quantitative fidelity assessment (Implementation outcome)
The proportion of participants with confirmed viewing of the "Getting Ready" video, which will only be assessed for the Education and Education-Plus groups.
Time frame: Within 12 weeks after randomization
Completed Motivational Interviewing Sessions - quantitative fidelity assessment (Implementation outcome)
The proportion of participants who completed the scheduled motivational interviewing sessions (only be assessed for the Education-Plus group)
Time frame: Within 12 months after randomization
Brochure Delivery Mode - quantitative barriers/facilitators assessment (Implementation outcome)
The selected mode for delivery of the "Getting Ready" brochure by center, clinic, and participant sociodemographic characteristics.
Time frame: Within 12 weeks after randomization
Video Delivery Mode - quantitative barriers/facilitators assessment (Implementation outcome)
The selected mode for viewing of the "Getting Ready" video by center, clinic, and participant sociodemographic characteristics.
Time frame: Within 12 weeks after randomization
Participant Contact Attempts for Motivational Interviewing - quantitative barriers/facilitators assessment (Implementation outcome)
The number and type (email, phone, text messaging) of attempted and confirmed participant contacts by the motivational interviewing coach.
Time frame: 12 month period after randomization
Missed Motivational Interviewing Sessions - quantitative barriers/facilitators assessment (Implementation outcome)
The number of missed motivational interviewing sessions.
Time frame: 12 month period after randomization
System-Level Barriers to Arteriovenous Access Creation From Clinical Staff Perspective - qualitative implementation/barriers assessment (Implementation outcome)
System-level barriers to arteriovenous vascular access creation and relevant system contextual factors as identified through qualitative interviews.
Time frame: Up to 4 years after trial initiation (full duration of the trial)
System-Level Barriers to Arteriovenous Access Creation From Participant Perspective - qualitative implementation/barriers assessment (Implementation outcome)
System-level barriers to arteriovenous vascular access creation and relevant system contextual factors as identified through qualitative interviews.
Time frame: Within 12 months
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